Eguchi Yawara, Suzuki Munetaka, Yamanaka Hajime, Tamai Hiroshi, Kobayashi Tatsuya, Orita Sumihisa, Yamauchi Kazuyo, Suzuki Miyako, Inage Kazuhide, Fujimoto Kazuki, Kanamoto Hirohito, Abe Koki, Aoki Yasuchika, Toyone Tomoaki, Ozawa Tomoyuki, Takahashi Kazuhisa, Ohtori Seiji
Department of Orthopaedic Surgery, Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba 284-0003 Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670 Japan.
Scoliosis Spinal Disord. 2017 Mar 16;12:9. doi: 10.1186/s13013-017-0116-0. eCollection 2017.
Age-related sarcopenia can cause various forms of physical disabilities. We investigated how sarcopenia affects degenerative lumbar scoliosis (DLS) and lumbar spinal canal stenosis (LSCS).
Subjects comprised 40 elderly women (mean age 74 years) with spinal disease whose chief complaints were low back pain and lower limb pain. They included 15 cases of DLS (mean 74.8 years) and 25 cases of LSCS (mean age 72.9 years). We performed whole-body dual-energy X-ray absorptiometry (DXA) to analyze body composition, including appendicular and trunk skeletal muscle mass index (SMI; lean mass (kg)/height (m)) and bone mineral density (BMD). A diagnostic criterion for sarcopenia was an appendicular SMI <5.46. To check spinal alignment, lumbar scoliosis (LS), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and vertebral rotational angle (VRA) were measured. Clinical symptoms were determined from the Japanese Orthopedic Association scores, low back pain visual analog scale, and Roland-Morris Disability Questionnaire (RDQ). Criteria for DLS were lumbar scoliosis >10° and a sagittal vertical axis (SVA) >50 mm. Sarcopenia prevalence, correlations between spinal alignment, BMD, and clinical symptoms with appendicular and trunk SMIs, and correlation between spinal alignment and clinical symptoms were investigated.
DLS cases had significantly lower body weight, BMI, lean mass arm, and total lean mass than LSCS cases. Sarcopenia prevalence rates were 4/25 cases (16%) in LSCS and 7/15 cases (46.6%) in DLS, revealing a high prevalence in DLS. Appendicular SMIs were DLS 5.61 and LSCS 6.13 ( < 0.05), and trunk SMIs were DLS 6.91 and LSCS 7.61 ( < 0.01) showing DLS to have significantly lower values than LSCS. Spinal alignment correlations revealed the appendicular SMI was negatively correlated with PT ( < 0.05) and the trunk SMI was found to have a significant negative correlation with SVA, PT, LS, and VRA ( < 0.05). The trunk SMI was found to have a significant positive correlation with BMD ( < 0.05). As for clinical symptoms, RDQ was negatively correlated with appendicular SMI and positively correlated with PT ( < 0.05).
Sarcopenia complications were noted in 16% of LSCS patients and a much higher percentage, or 46.6%, of DLS patients. Appendicular and trunk SMIs were both lower in DLS, suggesting that sarcopenia may be involved in scoliosis. The appendicular skeletal muscle was related to posterior pelvic tilt, while the trunk muscle affected stooped posture, posterior pelvic tilt, lumbar scoliosis, and vertebral rotation. Decreases in trunk muscle mass were also associated with osteoporosis. Moreover, RDQ had a negative correlation with appendicular skeletal muscle mass and a positive correlation with PT, suggesting that sarcopenia may be associated with low back pain as a result of posterior pelvic tilt. Our research reveals for the first time how sarcopenia is involved in spinal deformations, suggesting decreases in pelvic/lumbar support structures such as trunk and appendicular muscle mass may be involved in the progression of spinal deformities and increased low back pain.
与年龄相关的肌肉减少症可导致各种身体残疾。我们研究了肌肉减少症如何影响退行性腰椎侧弯（DLS）和腰椎管狭窄症（LSCS）。
研究对象为40名患有脊柱疾病的老年女性（平均年龄74岁），她们的主要症状是腰痛和下肢疼痛。其中包括15例DLS患者（平均74.8岁）和25例LSCS患者（平均年龄72.9岁）。我们进行了全身双能X线吸收法（DXA）以分析身体成分，包括四肢和躯干骨骼肌质量指数（SMI；瘦体重（kg）/身高（m））和骨密度（BMD）。肌肉减少症的诊断标准为四肢SMI<5.46。为检查脊柱排列情况，测量了腰椎侧弯（LS）、矢状垂直轴（SVA）、胸椎后凸（TK）、腰椎前凸（LL）、骨盆倾斜度（PT）、骨盆入射角（PI）、骶骨倾斜度（SS）和椎体旋转角度（VRA）。根据日本骨科协会评分、腰痛视觉模拟量表和罗兰-莫里斯残疾问卷（RDQ）确定临床症状。DLS的标准为腰椎侧弯>10°且矢状垂直轴（SVA）>50mm。研究了肌肉减少症的患病率、脊柱排列、骨密度和临床症状与四肢和躯干SMI之间的相关性，以及脊柱排列与临床症状之间的相关性。
DLS患者的体重、BMI、瘦体重手臂和总瘦体重均显著低于LSCS患者。LSCS患者的肌肉减少症患病率为4/25例（16%），DLS患者为7/15例（46.6%），表明DLS的患病率较高。四肢SMI在DLS患者中为5.61，在LSCS患者中为6.13（<0.05），躯干SMI在DLS患者中为6.91，在LSCS患者中为7.61（<0.01），表明DLS的值显著低于LSCS。脊柱排列相关性显示，四肢SMI与PT呈负相关（<0.05），躯干SMI与SVA、PT、LS和VRA呈显著负相关（<0.05）。发现躯干SMI与BMD呈显著正相关（<0.05）。至于临床症状，RDQ与四肢SMI呈负相关，与PT呈正相关（<0.05）。
16%的LSCS患者和更高比例（46.6%）的DLS患者存在肌肉减少症并发症。DLS患者的四肢和躯干SMI均较低，这表明肌肉减少症可能与脊柱侧弯有关。四肢骨骼肌与骨盆后倾有关，而躯干肌肉影响弯腰姿势、骨盆后倾、腰椎侧弯和椎体旋转。躯干肌肉量的减少也与骨质疏松症有关。此外，RDQ与四肢骨骼肌质量呈负相关，与PT呈正相关，这表明肌肉减少症可能与骨盆后倾导致的腰痛有关。我们的研究首次揭示了肌肉减少症如何与脊柱畸形相关，表明躯干和四肢肌肉量等骨盆/腰椎支撑结构的减少可能与脊柱畸形的进展和腰痛增加有关。
